MEDICARE: TRACI A KURTZER MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036091007	IL

General Provider Information

NPI Number	:	1053544759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACI A KURTZER MD SC

Provider Business Mailing Address
First Line	:	636 CHURCH ST STE 217
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4578
Country	:	US
Telephone Number	:	847-328-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 CHURCH ST STE 217
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4578
Country	:	US
Telephone Number	:	847-328-0238
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACI A KURTZER
Credential	:	M.D
Telephone Number	:	847-328-0238

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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